Elsevier

Social Science & Medicine

Volume 75, Issue 12, December 2012, Pages 2060-2068
Social Science & Medicine

Integrating social epidemiology into immigrant health research: A cross-national framework

https://doi.org/10.1016/j.socscimed.2012.04.040Get rights and content

Abstract

Scholarship on immigrant health has steadily increased over the past two decades. This line of inquiry is often approached as a “specialty” topic involving a discrete de-contextualized population, rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently immigrant health research employs theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while less commonly utilized is the “social determinants of health” framework, which emphasizes social and structural explanations. Drawing upon literature in the fields of economics, sociology of immigration, and social epidemiology, we present a conceptual framework for understanding immigrant health from a cross-national perspective. We discuss the theoretical foundations of this framework; the methodological challenges for undertaking research on immigration and health using this framework; examples of emerging research in this area; and directions for future research. Progress in immigrant health research and population health improvements can be achieved through an enhanced understanding of population health patterns in sending and receiving societies. Immigrant health research needs to be better integrated into social epidemiology. Concurrently, immigrant health research offers conceptual, empirical, and analytic opportunities to advance social epidemiological research. Together, scholarship in immigrant health and social epidemiology can make significant contributions toward one of their mutual and ultimate goals: to improve knowledge about population health.

Highlights

► Immigrant health research needs to address the social determinants of health cross-nationally and along the lifecourse. ► A cross-national framework integrates the sending and receiving context, the migration process, and transnational ties. ► Newer research on socioeconomic patterning of health contextualizes immigrant health in sending and receiving countries. ► Progress in immigrant health research is linked to an improved understanding of cross-national factors.

Introduction

Migration between countries is at higher levels than ever before. The movement of people across national boundaries influences economic development, labor, and population health (World Health Organization, 2010). In response to these trends, the number of policies with implications for immigrant health, and the number of studies on immigrant health have steadily increased over the last two decades.

The realities of immigration have resulted in cross-national policy responses (Zimmerman, Kiss, & Hossain, 2011). National economies, the development of sending communities, and individual families in sending societies partly depend on immigrant productivity in receiving countries and the monetary remittances of immigrants (Inter-American Development Bank, 2009). Recognizing the importance of remittances for sending societies, along with the often limited access to health and social services for immigrants in receiving societies, some sending countries have established cross-national services to assist their immigrant co-nationals. Thus, it is increasingly recognized that health and social policies within and between countries can have substantial influence on the health of immigrants, their families, and the population health patterns within sending and receiving countries (Zimmerman et al., 2011). This wider recognition of the importance of cross-national processes, however, is not yet consistently reflected in the scholarship on immigrant health.

In addition, research on immigrant health is often approached as a “specialty” topic involving a discrete de-contextualized population rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently, the health of immigrants in host societies is examined using theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while the social determinants of health framework, which emphasizes social and structural explanations, is less commonly utilized. When social determinants (e.g., SES, gender) are examined, they are infrequently placed in the context of the sending and/or receiving society, or within the context of migration and adaptation processes. Important empirical studies dating primarily since 2000 (e.g., Buttenheim, Goldman, Pebley, Wong, & Chung, 2010; Gong, Xu, Fujishiro, & Takeuchi, 2011; Kimbro, Bzostek, Goldman, & Rodriguez, 2008) have addressed some cross-national issues, such as the extent of health selection in migration processes. However, few studies integrate comprehensive theoretical frameworks of cross-national influences on immigrant health.

The need for a comprehensive cross-national framework is increasingly recognized, as highlighted in a recent series of papers that focused on policy responses to address the health of immigrants across national boundaries (Zimmerman et al., 2011). Our paper draws upon several theories of migration with the goal of integrating these diverse and independent research streams in order to provide a more cohesive conceptual basis for the study of immigrant health.

Our goal is to propose an integrative conceptual framework for understanding immigrant health from a cross-national perspective—that is, one that explicitly and systematically considers the possible influences of both the sending and receiving countries on immigrant health. To this end, we draw upon literature in the fields of economics, sociology of immigration, and social epidemiology. We begin by defining our use of the term “cross-national” and discussing the framework and its elements. We then elaborate on the theoretical foundations of this framework and the methodological challenges for undertaking research on immigration and health using this framework. We conclude with examples of emerging research in this area and directions for future research.

Section snippets

What is a cross national perspective?

We use the term “cross-national” to refer to influences on health outcomes that derive from immigrants' sending and receiving contexts and from the immigration process. While some of these influences are exchanges between places (e.g., economic remittances), others occur at different points in time and without agency on the part of immigrants (e.g., health-related exposures during childhood in the sending country). Thus, the proposed cross-national framework is different from the concept of

A cross-national framework for understanding immigrant health

The health of non-immigrants is primarily influenced by the societies they live in, while the health of immigrants (as well as their families and communities of origin) is embedded in both sending and receiving societies. As depicted in Fig. 1 and discussed further below, sending-country (i.e., country of origin) factors may influence immigrant health before and after immigration, along the lifecourse, alone or in combination with receiving-country (i.e., country of destination) factors. The

Theories to inform cross-national research

In the past, research on immigrant health had often favored conceptual frameworks and interpretations that focused primarily on cultural factors, e.g., acculturation. In the last decade, researchers have called for greater attention to the social determinants of immigrant health (Hunt, 1999; Hunt, Schneider, & Corner, 2004; Viruell-Fuentes, 2007), and empirical studies are increasingly using a social determinants framework. For example, several studies have examined socioeconomic gradients in

Research using a cross-national perspective

An integrated cross-national perspective has not been consistently applied in health research, though we have found four bodies of empirical work that explicitly acknowledge or imply a cross-national framework: immigrant health selection; socioeconomic patterning of health among immigrants; health effects of pre-immigration factors; and health effects of remittances. We briefly discuss these approaches and highlight how they can inform cross-national research.

Directions for future research

A cross-national framework suggests several substantive research areas for future work on immigrant health, including: (1) examining the population-level implications of immigration for health in both receiving and sending countries; (2) further investigating whether immigrants from and to different regions are health selected, and the health implications for immigrants following migration; (3) improving the conceptualization and measurement of migration histories and adaptation processes, and

Conclusion

Progress in immigrant health research is linked to an improved understanding of population health patterns in sending and receiving societies. Conceptually, methodologically, and analytically, immigrant health research needs to be better integrated into social epidemiological research. At the same time, immigrant health research offers conceptual and empirical insights and analytic opportunities to advance social epidemiological research. The integration of immigrant health research with social

Acknowledgments

The authors are founding members of Place, Migration and Health: A Cross-national Research Network (PMH). They gratefully acknowledge the support of other PMH members, especially Barbara Krimgold and Debra Perez, as well as grant support for PMH from the Center for Advancing Health, The Robert Wood Johnson Foundation, and the David Rockefeller Center for Latin American Studies at Harvard University.

The authors also acknowledge support from the W.K. Kellogg Foundation to Dr. Acevedo-Garcia; from

References (76)

  • E.A. Viruell-Fuentes et al.

    More than culture: structural racism, intersectionality theory, and immigrant health

    Social Science & Medicine

    (2012)
  • L. Abrego

    Economic well-being in Salvadoran transnational families: how gender affects remittance practices

    Journal of Marriage and Family

    (2009)
  • D. Acevedo-Garcia et al.

    The differential effect of foreign-born status on low-birthweight by race/ethnicity and education

    Pediatrics

    (2005)
  • I.R. Akresh et al.

    Health selection among new immigrants

    American Journal of Public Health

    (2008)
  • L.G. Basch et al.

    Nations unbound: Transnational projects, postcolonial predicaments, and deterritorialized nation-states

    (1994)
  • Y. Ben-Shlomo et al.

    A life course approach to chronic disease epidemiology: conceptual models, empirical challenges, and interdisciplinary perspectives

    International Journal of Epidemiology

    (2002)
  • G.J. Borjas et al.

    Who leaves? The emigration of the foreign-born

    Review of Economics and Statistics

    (1996)
  • R. Capps et al.

    How are immigrants faring after welfare reform? Preliminary evidence from Los Angeles and New York city – Final report

    (2002)
  • L. Chauvet et al.

    Are remittances more effective than aid to improve child health? An empirical assessment using inter and intra-country data

    (2008)
  • S. Cohen et al.

    Childhood socioeconomic status and adult health

    Annals of the New York Academy of Sciences

    (2010)
  • E. Crimmins et al.

    Using anthropometric indicators for Mexicans in the United States and Mexico to understand the selection of migrants and the “Hispanic paradox”

    Social Biology

    (2005)
  • K.M. Donato et al.

    A glass half full? Gender in migration studies1

    International Migration Review

    (2006)
  • R. Frank

    International migration and infant health in Mexico

    Journal of Immigrant Health

    (2005)
  • R. Frank et al.

    The relationship between remittances and health care provision in Mexico

    American Journal of Public Health

    (2009)
  • N. Goldman et al.

    Socioeconomic gradients in health for White and Mexican-origin populations

    American Journal of Public Health

    (2006)
  • K. Greder et al.

    Exploring relationships between transnationalism and housing and health risks of rural Latino immigrant families

    Family and Consumer Sciences Research Journal

    (2009)
  • J. Gupta et al.

    Premigration exposure to political violence and perpetration of intimate partner violence among immigrant men in Boston

    American Journal of Public Health

    (2009)
  • J.R. Harris et al.

    Migration, unemployment and development: a two-sector analysis

    American Economic Review

    (1970)
  • J. Heymann et al.

    The impact of migration on the well-being of transnational families: new data from sending communities in Mexico

    Community, Work & Family

    (2009)
  • L.M. Hunt

    The concept of acculturation in health research: Assumptions about rationality and progress

    (1999)
  • Inter-American Development Bank

    IDB estimates of 2008 remittance flows to Latin America and the Caribbean

    (2009)
  • J. Itzigsohn et al.

    Mapping Dominican transnationalism: narrow and broad transnational practices

    Ethnic and Racial Studies

    (1999)
  • G. Jasso

    Migration, human development and the life course

  • S. Kanaiaupuni et al.

    Migradollars and mortality: the effects of migration on infant survival in Mexico

    Demography

    (1999)
  • S. Kar et al.

    Risk factors for cardiovascular diseases: is the social gradient reversing in northern India?

    National Medical Journal of India

    (2010)
  • N. Kaushal

    Adversities of acculturation? Prevalence of obesity among immigrants

    Health Economics

    (2009)
  • R.T. Kimbro et al.

    Race, ethnicity, and the education gradient in health

    Health Affairs

    (2008)
  • D.L. Koya et al.

    Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants

    Journal of General Internal Medicine

    (2007)
  • Cited by (165)

    View all citing articles on Scopus
    View full text